1,552 research outputs found
Engaging for-profit providers in TB control: lessons learnt from initiatives in South Asia.
There has been a huge expansion in the private health-care sector over the past two decades, particularly in South Asia, resulting in over 80% of patients seeking care from private health providers. Despite concerns about the quality and equity of private sector service provision, most government public health bodies recognize that the private sector reaches individuals that public institutions cannot cater to, thereby being important in moving closer to universal health coverage. Numerous initiatives have been launched and are being planned to involve private practitioners in effectively diagnosing, reporting and managing infectious diseases such as tuberculosis. However, there is a notable dearth of papers discussing which elements of private sector engagement strategies are more or less successful and the ethical issues that arise when engagement strategies are operationalized. This article brings together the authors' experiences of working on projects to engage private allopathic health providers in Pakistan, Bangladesh and India for improved tuberculosis control. Motivations of and strategies required to engage private allopathic heath providers, specifically doctors, diagnostic laboratories and pharmacies, and some of the ethical issues that arise when designing programmes for engagement are discussed
Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory.
BACKGROUND: Public Private Partnerships (PPP) are increasingly utilized as a public health strategy for strengthening health systems and have become a core component for the delivery of TB control services in India, as promoted through national policy. However, partnerships are complex systems that rely on relationships between a myriad of different actors with divergent agendas and backgrounds. Relationship is a crucial element of governance, and relationship building an important aspect of partnerships. To understand PPPs a multi-disciplinary perspective that draws on insights from social theory is needed. This paper demonstrates how social theory can aid the understanding of the complex relationships of actors involved in implementation of Public-Private Mix (PPM)-TB policy in India. METHODS: Ethnographic research was conducted within a district in a Southern state of India over a 14 month period, combining participant observations, informal interactions and in-depth interviews with a wide range of respondents across public, private and non-government organisation (NGO) sectors. RESULTS: Drawing on the theoretical insights from Bourdieu's "theory of practice" this study explores the relationships between the different actors. The study found that programme managers, frontline TB workers, NGOs, and private practitioners all had a crucial role to play in TB partnerships. They were widely regarded as valued contributors with distinct social skills and capabilities within their organizations and professions. However, their potential contributions towards programme implementation tended to be unrecognized both at the top and bottom of the policy implementation chain. These actors constantly struggled for recognition and used different mechanisms to position themselves alongside other actors within the programme that further complicated the relationships between different actors. CONCLUSION: This paper demonstrates that applying social theory can enable a better understanding of the complex relationship across public, private and NGO sectors. A closer understanding of these processes is a prerequisite for bridging the gap between field-level practices and central policy intentions, facilitating a move towards more effective partnership strategies for strengthening local health systems. The study contributes to our understanding of implementation of PPP for TB control and builds knowledge to help policy makers and programme managers strengthen and effectively implement strategies to enable stronger governance of these partnerships
Improving Care of Patients At-Risk for Osteoporosis: A Randomized Controlled Trial
BACKGROUND: Despite accurate diagnostic tests and effective therapies, the management of osteoporosis has been observed to be suboptimal in many settings. We tested the effectiveness of an intervention to improve care in patients at-risk of osteoporosis. DESIGN: Randomized controlled trial. PARTICIPANTS: Primary care physicians and their patients at-risk of osteoporosis, including women 65 years and over, men and women 45 and over with a prior fracture, and men and women 45 and over who recently used ≥90 days of oral glucocorticoids. INTERVENTION: A multifaceted program of education and reminders delivered to primary care physicians as well as mailings and automated telephone calls to patients. Outcome: Either undergoing a bone mineral density (BMD) testing or filling a prescription for a bone-active medication during the 10 months of follow-up. RESULTS: After the intervention, 144 (14%) patients in the intervention group and 97 (10%) patients in the control group received either a BMD test or filled a prescription for an osteoporosis medication. This represents a 4% absolute increase and a 45% relative increase (95% confidence interval 9–93%, p = 0.01) in osteoporosis management between the intervention and control groups. No differences between groups were observed in the incidence of fracture. CONCLUSION: An intervention targeting primary care physicians and their at-risk patients increased the frequency of BMD testing and/or filling prescriptions for osteoporosis medications. However, the absolute percentage of at-risk patients receiving osteoporosis management remained low
Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State
Background: Public and private health sectors both play a crucial role in the health systems of low- and middleincome countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively
partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring
effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from
an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control
programme in India.
Methods: The study was carried out between November 2010 and December 2011 in a district of a Southern Indian
State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from
different medical systems. The collected data was coded and analysed using thematic analysis.
Results: PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private
mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of
the PPM-TB policy. The entire process was considered to be government driven and their professional skills and
knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship
and bond with the policy and with the programme. PPs had contrasting perceptions about the different components
of the TB programme that demonstrated the public sector’s dominance in the overall implementation of the DOTS
strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as ‘partners
with the TB programme.’
Conclusion: Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen
health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement
in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be
recognised and supporte
The Substance Abuse Treatment Workforce of South Africa
The purpose of this paper is to describe characteristics of substance abuse treatment counselors in the Republic of South Africa, including demographics, education, training, and job duties. Counselors recruited from 24 treatment centers completed a survey after signing informed consent. Counselors were primarily female (75%), racially diverse (36.4% White, 30.8% Black, 18.9% Coloured, 12.6% Indian or Asian, and 1.4% Cape Malay), and were 38 years old on average. The majority (62.3%) held at least an equivalent of a bachelor’s degree, and just under half (49%) were registered social workers. Counselors had a mean of 5.3 years’ experience in substance abuse treatment. The substance abuse treatment workforce of South Africa appears to be young and educated, yet only one third of the counselors had any formal training in Cognitive Behavioral Therapy. South African counselors could benefit from more training in evidence-based techniques
Vigorous star formation hidden by dust in a galaxy at
Near-infrared surveys have revealed a substantial population of enigmatic
faint galaxies with extremely red optical-to-near-infrared colours and with a
sky surface density comparable to that of faint quasars. There are two
scenarios for these extreme colours: (i) these distant galaxies have formed
virtually all their stars at very high redshifts and, due to the absence of
recently formed stars, the colours are extremely red and (ii) these distant
galaxies contain large amounts of dust, severely reddening the rest-frame
UV--optical spectrum. HR10 () is considered the archetype of the
extremely red galaxies. Here we report the detection of the continuum emission
from HR10 at 850m and at 1250m, demonstrating that HR10 is a very
dusty galaxy undergoing a major episode of star formation. Our result provides
a clear example of a high-redshift galaxy where the star formation rate
inferred from the ultraviolet luminosity would be underestimated by a factor up
to 1000, and shows that great caution should be used to infer the global star
formation history of the Universe from optical observations only.Comment: 12 pages, 1 figure, Nature, in press (30 April 1998
The Effect of Interocular Phase Difference on Perceived Contrast
Binocular vision is traditionally treated as two processes: the fusion of similar images, and the interocular suppression of dissimilar images (e.g. binocular rivalry). Recent work has demonstrated that interocular suppression is phase-insensitive, whereas binocular summation occurs only when stimuli are in phase. But how do these processes affect our perception of binocular contrast? We measured perceived contrast using a matching paradigm for a wide range of interocular phase offsets (0–180°) and matching contrasts (2–32%). Our results revealed a complex interaction between contrast and interocular phase. At low contrasts, perceived contrast reduced monotonically with increasing phase offset, by up to a factor of 1.6. At higher contrasts the pattern was non-monotonic: perceived contrast was veridical for in-phase and antiphase conditions, and monocular presentation, but increased a little at intermediate phase angles. These findings challenge a recent model in which contrast perception is phase-invariant. The results were predicted by a binocular contrast gain control model. The model involves monocular gain controls with interocular suppression from positive and negative phase channels, followed by summation across eyes and then across space. Importantly, this model—applied to conditions with vertical disparity—has only a single (zero) disparity channel and embodies both fusion and suppression processes within a single framework
Targeting Chemoprevention of Colorectal Cancer to Those Who Are Likely to Respond
In the past four decades, chemoprevention of colorectal cancer (CRC) has been the subject of many epidemiologic and intervention trials of naturally occurring or pharmacologic agents. Recently, the positioning of cyclooxygenase 2 inhibitors as a viable option in this context was a major breakthrough; however, it was hampered by adverse cardiovascular events. This review questions whether chemopreventive measures for CRC are ready to be used in mass or individual applications, standing alone or in combination with other CRC-preventive measures. It also discusses steps that may be undertaken to explore this field further
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